Female urinary incontinence

Question 1

What is urinary incontinence?

Answer 1

Any involuntary leakage of urine

Question 2

What is stress incontinence?

Answer 2

Involuntary leakage on effort or exertion eg sneezing/coughing

Question 3

What is urge incontinence?

Answer 3

Involuntary leakage accompanied by or immediately preceded by urgency

Question 4

Does prevalence of urinary incontinence increase with age?

Answer 4

Yes

Question 5

What are risk factors for urinary incontinence?

Answer 5

Age
Parity
Menopause
Smoking
Medical problems
Increased intraabdominal  pressure
Pelvic floor trauma
Denervation
Connective tissue disease
Surgery

Question 6

What questions should be asked in the history of a patient presenting with urinary incontinence?

Answer 6

Age
Parity
Mode of deliveries
Weight of heaviest baby
Smoking
Diabetes
Anti hypertension medicines
Heart/kidney/liver problems
Previous pelvic floor muscle training/surgical treatment

Question 7

What should be examined in a woman with bladder/pelvic floor problems?

Answer 7

Prolapse
Stress incontinence
Uro-genital atrophy changes
Pelvic mass
Pelvic floor tone, strength, awareness

Question 8

What investigations can be done into urinary incontinence?

Answer 8

Urinalysis
Post voiding residual volume assessment
Urodynamics

Question 9

What is uroflowmetry?

Answer 9

Measures flow rate of urine in ml/s

Question 10

What determines flow rate of urine?

Answer 10

Urethral resistance, strength of detrusor contraction, and abdominal straining

Question 11

How is urinary incontinence managed?

Answer 11

Lifestyle changes
Medical treatments
Physiotherapy
Surgery

Question 12

What lifestyle changes can be made to improve urinary incontinence?

Answer 12

Stop smoking
Lose weight
Eat more healthily
Stop drinking alcohol and caffeine

Question 13

Why might someone not receive conservative treatment of urinary incontinence?

Answer 13

Patient doesn’t wish it
Previously failed
No facilities

Question 14

What are benefits to pelvic floor muscle training?

Answer 14

Reinforcement of cortical awareness of muscle groups
Hypertrophy of existing muscle fibres
General increase in muscle tone and strength

Question 15

What drug can be used for treatment of stress urinary incontinence?

Answer 15

Yentreve (duloxetine)

Question 16

Should duloxetine be used alone for treatment?

Answer 16

No - used alongside pelvic floor muscle training

Question 17

Who would require duloxetine in primary care?

Answer 17

If pelvic floor muscle training has failed or would be enhanced by prescription of duloxetine

Question 18

When would someone require duloxetine in secodary care?

Answer 18

Does not wish surgery
Not fit for surgery
After failed surgery
When patients family is not complete

Question 19

What is overactive bladder syndrome?

Answer 19

A symptom complex usually, but not always, related to urodynamically demonstable detrusor overactivity

Question 20

What are defining symptoms of overactive bladder syndrome?

Answer 20

Urgency (with/without urgency incontinence), usually with frequency and nocturia

Question 21

What are risk factors for urge incontinence?

Answer 21

Advanced age
Diabetes
UTI
Smoking

Question 22

How should overactive bladder be managed?

Answer 22

Treat symptoms
No immediate cure
Multidisciplinary approach
Requires dedicated team

Question 23

What are lifestyle interventions for overactive bladder?

Answer 23

Normalise fluid intake
Reduce caffeine, fizzy drinks, chocolate
Stop smoking
Weight loss